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The Annals of Thoracic Surgery, Vol 49, 202-208, Copyright © 1990 by The Society of Thoracic Surgeons
AC Fiore, KS Naunheim, P Dean, GC Kaiser, G Pennington, VL Willman, LR McBride and HB Barner
One hundred consecutive patients who had coronary artery bypass grafting
using both internal thoracic arteries (ITAs) and saphenous veins, operated
on during a 3-year period between 1972 and 1975, have been compared
retrospectively with a series of 100 patients operated on during the same
period who had one ITA graft along with saphenous vein grafts. The two
groups were similar with respect to age, sex, risk factors for coronary
artery disease, angina class, extent of coronary artery disease, left
ventricular function, number of coronary bypass grafts performed, and
completeness of revascularization. Single ITA operative mortality was 2%
and double ITA, 9% (p = NS). The mean follow- up of hospital survivors was
14.4 +/- 2.7 years; all but 7 patients had follow-up for at least 10 years.
At 13 years, the actuarial patency of the right ITA was 85% and the left
ITA, 82%. These data strongly suggest a survival benefit for patients with
double ITA grafts among hospital survivors (74% versus 59%; p = 0.05).
Patients receiving two ITA grafts had a significant freedom from subsequent
myocardial infarction (75% versus 59%, p less than 0.025), recurrent angina
pectoris (36% versus 27%, p less than 0.025), and subsequent total ischemic
events (32% versus 18%, p less than 0.01). These data also suggest improved
freedom from coronary artery interventional therapy (percutaneous
transluminal coronary angioplasty and reoperation) when two ITA grafts were
used. These results support the use of bilateral internal thoracic artery
grafting in selected patients.
ARTICLES
Results of internal thoracic artery grafting over 15 years: single versus double grafts
Division of Cardiothoracic Surgery, St. Mary's Health Center, St. Louis, MO 63117.
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